Heterogeneity in assessments of rheumatoid arthritis (RA) disease remission, based on physician judgment and patient self-reports versus standardized measures, have previously been reported. This study explored the prevalence and types of discordance between physician perception versus objective data of RA disease activity in real-world clinical practice in the US. Data were from the Adelphi RA Disease Specific Programme (DSP; January to March 2014), a cross-sectional survey of US rheumatologists and their patients. RA remission based on physician judgment versus Disease Activity Score in 28 joints (3)-erythrocyte sedimentation rate (DAS28(3)-ESR) and Clinical Disease Activity Index (CDAI) scores were compared using descriptive analyses; patient and physician factors associated with discordance were identified using bivariate and multivariate analyses. Of 101 rheumatologists participating (completing patient-record forms for 843 patients), 56.4% based assessment of remission on clinical judgment alone. Of 531 patients eligible for the discordance analysis, 49.7% were in remission based on rheumatologists’ evaluation, and 30.7% were eligible based on DAS28(3)-ESR. Compared with DAS28(3)-ESR criteria, 25.8% of patients’ disease remission was negatively discordant (overestimated remission) based on clinical perception. These patients were mostly administered biologic disease-modifying antirheumatic drugs and were without a treat-to-target strategy followed by their rheumatologist (P < 0.05). These patients were also more likely to have experienced a higher level of pain as well as increased joint inflammation and damage (e.g. destruction of cartilage, thinning of bone, and/or synovium inflammation) compared with concordant patients (P < 0.005). Conversely, 6.8% of rheumatologists were positively discordant (under estimated remission) versus the DAS28(3)-ESR. Sensitivity analysis indicated different levels of discordance using CDAI, with 35.6% negative discordance and 1.3% positive discordance of rheumatologist-assessed disease remission compared with objective data. There is discordance between RA remission as assessed by rheumatologist perception versus standardized measures among those in the US DSP sample. Our study identified the factors associated with the discordance which may inform strategies to enhance assessments of RA disease remission.

中文翻译：

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美国真实世界临床实践中类风湿性关节炎疾病活动标准化测量的医师感知与客观数据之间不一致的普遍性和类型

以前曾报道过基于医生判断和患者自我报告与标准化措施评估类风湿性关节炎 (RA) 疾病缓解的异质性。本研究探讨了在美国现实世界临床实践中医生感知与 RA 疾病活动的客观数据之间不一致的普遍性和类型。数据来自 Adelphi RA 疾病特定计划（DSP；2014 年 1 月至 2014 年 3 月），这是一项针对美国风湿病学家及其患者的横断面调查。使用描述性分析比较基于医师判断的 RA 缓解与 28 个关节 (3)-红细胞沉降率 (DAS28(3)-ESR) 中的疾病活动评分和临床疾病活动指数 (CDAI) 评分；使用双变量和多变量分析确定与不一致相关的患者和医生因素。在参与的 101 名风湿病学家（为 843 名患者填写病历表）中，56.4% 的缓解评估仅基于临床判断。在符合不一致分析的 531 名患者中，49.7% 的患者根据风湿病学家的评估处于缓解状态，30.7% 的患者根据 DAS28(3)-ESR 符合条件。与 DAS28(3)-ESR 标准相比，25.8% 的患者疾病缓解基于临床感知呈负不一致（高估缓解）。这些患者大多接受了改善疾病的生物抗风湿药物，并且没有接受风湿病专家治疗的靶向治疗策略（P < 0.05）。与一致的患者相比，这些患者也更有可能经历更高水平的疼痛以及增加的关节炎症和损伤（例如软骨破坏、骨骼变薄和/或滑膜炎症）（P < 0.005）。相反，与 DAS28(3)-ESR 相比，6.8% 的风湿病学家正不一致（低于估计缓解）。敏感性分析表明使用 CDAI 存在不同程度的不一致，与客观数据相比，风湿病学家评估的疾病缓解的阴性不一致和阳性不一致分别为 35.6% 和 1.3%。在美国 DSP 样本中，通过风湿病学家感知评估的 RA 缓解与标准化测量之间存在不一致。